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Wolff B, Vasseur V, Cahuzac A, Coscas F, Castelnovo L, Favard C, Michel G, Français C, Salomon L, Mauget-Faÿsse M. Aflibercept Treatment in Polypoidal Choroidal Vasculopathy: Results of a Prospective Study in a Caucasian Population. Ophthalmologica 2018; 240:208-212. [PMID: 29804123 DOI: 10.1159/000488808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/26/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Polypoidal choroidal vasculopathy (PCV) is a choroidal pathology characterized by frequent occurrences of subretinal hemorrhages and resistance to monotherapies such as ranibizumab or bevacizumab intravitreal injections (IVT). The purpose of this study is to evaluate both the anatomical and functional efficacy of aflibercept IVT as a monotherapy in PCV in a Caucasian population. METHODS We conducted a prospective multicenter study in either treatment-naïve patients with PCV or PVC patients who had not been treated with anti-VEGF within the previous 3 months or with photodynamic therapy (PDT) within the previous 6 months. All patients had been treated with 3 initial monthly loading doses of aflibercept followed by a Q8 regimen for 28 weeks in total. All patients underwent a complete ophthalmic examination including the measurement of best-corrected visual acuity (BCVA) before each IVT and after 28 weeks as well as an optical coherent tomography (OCT) of the macula. At baseline and 28 weeks, the polypoidal dilations were analyzed with indocyanine green angiography. RESULTS Thirty-four eyes of 34 patients were included in this study. All patients were followed for 28 weeks and received 5 aflibercept IVT. The mean baseline BCVA was 55 letters. After 28 weeks, significant +13 letters in BCVA and a regression of exudative signs on OCT in all patients were observed. In 62% of the cases, polyp disappearance was observed on indocyanine green angiography. DISCUSSION In this study on a Caucasian population, we showed that aflibercept as a monotherapy provided both a significant visual gain and the regression of polypoidal dilations. Aflibercept use in monotherapy may contribute to reduce the hemorrhagic risk and atrophy linked to PDT.
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Affiliation(s)
| | - Vivien Vasseur
- Adolphe de Rothschild Foundation, CIC Department, Paris, France
| | - Armelle Cahuzac
- Adolphe de Rothschild Foundation, CIC Department, Paris, France
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Chan EW, Eldeeb M, Govindhari V, Sarvaiya C, Banker A, Mansour A, Chhablani J. Treatment outcomes of ziv-aflibercept for treatment-naïve polypoidal choroidal vasculopathy. Acta Ophthalmol 2018; 96:e258-e259. [PMID: 28926212 DOI: 10.1111/aos.13533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Errol W. Chan
- Department of Ophthalmology; McGill University; Montreal Québec Canada
- Montreal Retina Institute; Montreal Québec Canada
| | - Mohab Eldeeb
- Montreal Retina Institute; Montreal Québec Canada
| | - Vishal Govindhari
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases; LV Prasad Eye Institute; Hyderabad Telangana India
| | | | - Alay Banker
- Banker's Retina Clinic and Laser Centre; Ahmedabad India
| | - Ahmad Mansour
- Department of Ophthalmology; American University of Beirut; Beirut Lebanon
- Department of Ophthalmology; Rafic Hariri University Hospital; Beirut Lebanon
| | - Jay Chhablani
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases; LV Prasad Eye Institute; Hyderabad Telangana India
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NATURAL COURSE OF PATIENTS DISCONTINUING TREATMENT FOR AGE-RELATED MACULAR DEGENERATION AND FACTORS ASSOCIATED WITH VISUAL PROGNOSIS. Retina 2018; 37:2254-2261. [PMID: 28092343 DOI: 10.1097/iae.0000000000001494] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To evaluate the 24-month natural course of visual changes in patients discontinuing treatment despite persistent or recurrent fluid and factors predictive of visual prognosis. METHODS This retrospective, observational study included 35 patients (35 eyes) who initially received anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration (AMD), but discontinued treatment despite persistent or recurrent fluid. The best-corrected visual acuity (BCVA) at treatment discontinuation was determined and compared with the 24-month BCVA, which was then compared between polypoidal choroidal vasculopathy and other neovascular age-related macular degeneration subtypes. Baseline characteristics predictive of visual outcome and the degree of visual change were also analyzed. RESULTS The mean number of anti-vascular endothelial growth factor injections before treatment discontinuation was 4.0 ± 1.6. The mean logarithm of minimal angle of resolution of BCVA at treatment discontinuation and that at 24 months were 1.02 ± 0.20 (Snellen equivalents = 20/209) and 1.60 ± 0.56 (20/796), respectively (P < 0.001). The 24-month BCVA was not different between polypoidal choroidal vasculopathy and other neovascular age-related macular degeneration subtypes (P = 0.803). The type of fluid (intraretinal fluid vs. no intraretinal fluid) was predictive of 24-month BCVA (P = 0.004) and the degree of changes in BCVA (P = 0.043). CONCLUSION Marked deterioration in visual acuity was noted in patients discontinuing treatment, regardless of neovascular age-related macular degeneration subtypes. The presence of intraretinal fluid was associated with worse visual prognosis, suggesting that patients with intraretinal fluid should be strongly warned about their poor prognosis before they decide to discontinue treatment.
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Peng Y, Zhang X, Li M, Liu B, Mi L, Zuo C, Wen F. Short-term efficacy of intravitreal conbercept in treatment-naive patients with polypoidal choroidal vasculopathy. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:339-345. [PMID: 29497280 PMCID: PMC5823069 DOI: 10.2147/dddt.s158368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction To evaluate the functional and morphological outcomes of intravitreal conbercept monotherapy in patients with polypoidal choroidal vasculopathy (PCV). Materials and methods In this retrospective, observational case series study, we reviewed medical records of 48 eyes (48 patients) with naive PCV that were treated with a series of 3 monthly intravitreal injections of 0.5 mg of conbercept followed by as-needed injections (3+pro re nata). All patients completed at least 6 months of monthly follow-up. Changes in the best-corrected visual acuity, optical coherence tomography, and indocyanine green angiography were retrospectively evaluated. Results At 6 months, the mean best-corrected visual acuity significantly improved from 0.89±0.35 (20/160 in Snellen equivalent) at baseline to 0.58±0.26 (Snellen equivalent of 20/80; P<0.001), and 60.42% (29/48) of eyes had an improvement of three lines of vision; the mean central retinal thickness significantly decreased from 333.56±171.04 μm at baseline to 187.65±54.46 μm (P<0.001), and 93.75% (45/48) achieved a dry macula. At 3 months, 6 of 32 eyes (18.75%) showed partial regression of branching vascular network, 14 of 32 (43.75%) patients showed complete resolution of polyps. The mean number of injections was 3.4±0.9 through 6 months. No conbercept-related systemic or ocular adverse effects were observed. Conclusion Intravitreal injection of conbercept using "3+pro re nata" regimen significantly improved visual acuity and anatomical outcomes in treatment-naive patients with PCV.
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Affiliation(s)
- Yuting Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiongze Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Miaoling Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Bing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lan Mi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chengguo Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Kim YJ, Han SY, Kim JW, Kim CG, Lee DW, Kim JH. Long-term Treatment Outcome of Intravitreal Aflibercept Monotherapy for Polypoidal Choroidal Vasculopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.3.238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ye Ji Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Sang Yun Han
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Qian T, Li X, Zhao M, Xu X. Polypoidal choroidal vasculopathy treatment options: A meta-analysis. Eur J Clin Invest 2018; 48:e12840. [PMID: 28981139 PMCID: PMC5771464 DOI: 10.1111/eci.12840] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/01/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Combined treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF) and verteporfin photodynamic therapy (PDT) is widely used for patients with polypoidal choroidal vasculopathy (PCV), although clinical evidence regarding the therapeutic efficacy and safety of such treatment remains lacking. DESIGN/METHODS We performed a meta-analysis of previously reported studies comparing combination treatment, PDT monotherapy, and anti-VEGF monotherapy. Primary outcome measures included changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT). The proportion of patients with polyp regression was regarded as the secondary outcome measure. RESULTS Twenty studies (three RCTs and 19 retrospective studies) involving 1,178 patients with PCV were selected. Significant differences in the proportion of patients with polyps were observed between the PDT and anti-VEGF monotherapy groups at 3 and ≥6 months (P < .00001; and P = .0001, respectively). Significantly greater reductions in CRT were observed in the anti-VEGF than in the PDT group at the 3-month follow-up (P = .04). Significantly greater improvements in BCVA were observed in the combined therapy group than in the PDT monotherapy group at 3, 6, 12, and 24 months (P = .03; P = .005; P = .02; and P < .00001, respectively). Combined treatment also resulted in significantly greater improvements in BCVA than monotherapy with anti-VEGF at 6 and 24 months (P = .001; P < .00001, respectively), and significantly greater polyp regression than that observed following anti-VEGF treatment at 3 and ≥6 months (P < .00001; P < .0001, respectively). CONCLUSIONS Combined therapy involving anti-VEGF agents and PDT may be more effective in improving long-term outcomes for patients with PCV than monotherapy.
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Affiliation(s)
- Tianwei Qian
- Department of Ophthalmology, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai, China
| | - Xinxin Li
- Department of Ophthalmology, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai, China
| | - Mengya Zhao
- Department of Ophthalmology, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai, China
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Tae KS, Kim JW, Kim CG, Lee DW, Kim JH. Long-term Recurrence in Neovascular Age-related Macular Degeneration or Polypoidal Choroidal Vasculopathy without First Year Recurrence. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.10.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Mohamad NA, Ramachandran V, Ismail P, Mohd Isa H, Chan YM, Ngah NF, Md Bakri N, Ching SM, Hoo FK, Wan Sulaiman WA. Prevalence and treatment patterns of ranibizumab and photodynamic therapy in a tertiary care setting in Malaysia. Int J Ophthalmol 2017; 10:1889-1897. [PMID: 29259909 PMCID: PMC5733518 DOI: 10.18240/ijo.2017.12.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/22/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To describe the prevalence and changes in treatment patterns of ranibizumab and photodynamic therapy (PDT) among retinal disease patients who attended the Ophthalmology Clinic in the tertiary care Hospital Selayang from 2010 to 2014. METHODS Study subjects were recruited retrospectively using the Electronic Medical Record (EMR) database software in Hospital Selayang. Demographic data, medical history, diagnostic procedure, treatments and diagnosis of patients were recorded. RESULTS The five-year analysis included 821 patients with a mean age of 65.9±11.73y. Overall, there were a higher number of males (63.1%) and a higher number of Chinese (47.4%) patients. Among the 821 patients, 62.9% received ranibizumab injection followed by 19.2% PDT therapy and 17.9% had ranibizumab combined with PDT therapy. Age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) were the most common retinal eye diseases reported, recording prevalence of 25.0% and 45.6%, respectively. The trend in ranibizumab treatment was reported to increase while PDT showed a decrease in trend from year 2010 to 2014. In terms of treatment, following multiple logistic regression, AMD was associated with the subjects being more likely to have received ranibizumab monotherapy (P<0.001) while PCV was associated with more likely to have received PDT (P<0.001) and PDT combined with ranibizumab therapy (P<0.001). CONCLUSION The tertiary care setting in Malaysia is consistent with management of patients from other countries whereby ranibizumab is the most common treatment given to patients with AMD, while PCV patients most commonly receive PDT and ranibizumab combined with PDT therapy.
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Affiliation(s)
- Nur Afiqah Mohamad
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Vasudevan Ramachandran
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Patimah Ismail
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Hazlita Mohd Isa
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur 56000, Malaysia
| | - Yoke Mun Chan
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Nor Fariza Ngah
- Department of Ophthalmology, Hospital Selayang, Lebuhraya Selayang-Kepong, Batu Caves 68100, Malaysia
| | - Norshakimah Md Bakri
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Wan Aliaa Wan Sulaiman
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
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Park UC, Shin JY, Chung H, Yu HG. Association of ARMS2 genotype with response to anti-vascular endothelial growth factor treatment in polypoidal choroidal vasculopathy. BMC Ophthalmol 2017; 17:241. [PMID: 29212537 PMCID: PMC5719580 DOI: 10.1186/s12886-017-0631-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/27/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To investigate whether genetic risk variants for age-related macular degeneration (AMD) are associated with response to intravitreal anti-vascular endothelial growth factor (VEGF) in polypoidal choroidal vasculopathy (PCV) patients. METHODS This prospective cohort study included 95 treatment-naïve patients that underwent anti-VEGF treatment for PCV for 12 months. Patients were genotyped for 10 single nucleotide polymorphisms in eight AMD-relevant genes. Genotypic association with visual and anatomic outcome measures at 12 months after initial treatment, including mean change in best-corrected visual acuity (BCVA) and total foveal thickness, visual gain of ≥ 15 letters, dry status on optical coherence tomography (OCT), pigment epithelial detachment (PED) regression on OCT, polyp regression on indocyanine green angiography, and injection numbers, were investigated using regression models with adjustment for non-genetic covariates under additive genetic model. RESULTS In 81 patients who completed 12-month anti-VEGF monotherapy without photodynamic therapy, significant pharmacogenetic association was found between ARMS2 rs10490924 and PED regression on OCT. Proportions of PED regression were 26.4% for TT, 45.7% for TG, and 63.6% for GG genotype, showing additive effect of G allele for higher chance of PED regression (OR, 2.96; 95% CI, 1.38-6.36; corrected P = 0.043). For entire 95 patients, no significant association was found between candidate polymorphisms and receiving photodynamic therapy within 12 months. CONCLUSIONS In PCV patients, ARMS2 rs10490924 showed association with anatomic therapeutic response to anti-VEGF, suggesting pharmacogenetic relationship.
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Affiliation(s)
- Un Chul Park
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.,Retinal Degeneration Research Laboratory, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Joo Young Shin
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.,Retinal Degeneration Research Laboratory, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Hum Chung
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.,Department of Ophthalmology, Chung-Ang University Hospital, Seoul, South Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea. .,Retinal Degeneration Research Laboratory, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
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Koh A, Lai TYY, Takahashi K, Wong TY, Chen LJ, Ruamviboonsuk P, Tan CS, Feller C, Margaron P, Lim TH, Lee WK. Efficacy and Safety of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy: A Randomized Clinical Trial. JAMA Ophthalmol 2017; 135:1206-1213. [PMID: 28983556 DOI: 10.1001/jamaophthalmol.2017.4030] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Polypoidal choroidal vasculopathy (PCV) is a common subtype of exudative age-related macular degeneration among Asian individuals. To our knowledge, there are no large randomized clinical trials to evaluate intravitreal ranibizumab, with and without verteporfin photodynamic therapy (vPDT), for the treatment of PCV. Objective To compare the efficacy and safety of combination therapy of ranibizumab and vPDT with ranibizumab monotherapy in PCV. Design, Setting, and Participants A double-masked, multicenter randomized clinical trial of 322 Asian participants with symptomatic macular PCV confirmed by the Central Reading Center using indocyanine green angiography was conducted between August 7, 2013, and March 2, 2017. Interventions Participants were randomized 1:1 to ranibizumab, 0.5 mg, and vPDT (n = 168; combination therapy group) or ranibizumab, 0.5 mg, and sham PDT (n = 154; monotherapy group). All participants received 3 consecutive monthly ranibizumab injections, followed by a pro re nata regimen. Participants also received vPDT/sham PDT on day 1, followed by a pro re nata regimen based on the presence of active polypoidal lesions. Main Outcomes and Measures Step 1 assessed whether combination therapy was noninferior (5-letter margin) to monotherapy for change in best-corrected visual acuity from baseline and superior in complete polyp regression. If noninferiority was established, step 2 assessed whether combination therapy was superior to monotherapy measured by best-corrected visual acuity change at month 12. Results Baseline demographics of the 322 participants were comparable between the treatment groups. Mean (SD) age of the patients was 68.1 (8.8) years, and overall, 69.9% of the patients were men. At baseline, the overall mean best-corrected visual acuity and mean central subfield thickness were 61.1 letters and 413.3 μm, respectively. At 12 months, mean improvement from baseline was 8.3 letters with combination therapy vs 5.1 letters with monotherapy (mean difference, 3.2 letters; 95% CI, 0.4-6.1), indicating that combination therapy met the predefined criterion for noninferiority as well as being superior to monotherapy (P = .01). Combination therapy was also superior to monotherapy in achieving complete polyp regression at month 12 (69.3% vs 34.7%; P < .001). Over 12 months, the combination therapy group received a median of 4.0 ranibizumab injections compared with 7.0 in the monotherapy group. Vitreous hemorrhage was the only ocular serious adverse event (combination therapy group, 1 [0.6%]; monotherapy group, 3 [2.0%]). Conclusions and Relevance After 12 months, combination therapy of ranibizumab plus vPDT was not only noninferior but also superior to ranibizumab monotherapy in best-corrected visual acuity and superior in complete polyp regression while requiring fewer injections. Combination therapy should be considered for eyes with PCV. Trial Registration clinicaltrials.gov Identifier: NCT01846273.
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Affiliation(s)
- Adrian Koh
- Eye and Retina Surgeons, Camden Medical Centre, Singapore, Singapore
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Hirakata Hospital, Osaka, Japan
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Lee-Jen Chen
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan
| | | | - Colin S Tan
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | | | - Tock H Lim
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Won Ki Lee
- Department of Ophthalmology, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Chen YN, Devenyi RG, Brent MH, Kertes PJ, Eng KT, Schwartz CE, Kohly RP, Chow DR, Wong DT, Berger AR, Altomare F, Giavedoni LR, Muni RH, Soon A, Yoo P, Lam WC. Age-related macular degeneration: is polypoidal choroidal vasculopathy recognized and treated? Can J Ophthalmol 2017; 52:475-479. [PMID: 28985807 DOI: 10.1016/j.jcjo.2017.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/14/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess how polypoidal choroidal vasculopathy (PCV) is recognized and treated, and to assess whether treatment outcomes are different between Chinese and Caucasian Canadian patients with age-related macular degeneration (AMD). DESIGN Retrospective chart review. PARTICIPANTS 154 eyes from 135 Chinese patients and 2291 eyes from 1792 Caucasian patients who were newly diagnosed with either AMD or PCV and had more than 1 year of follow-up were included. METHODS All newly diagnosed AMD patients presenting to the Retina Service of 3 Toronto University Hospitals, between March 25, 2008, to September 30, 2014, were reviewed. RESULTS 10/154 eyes (6.5%) in Chinese Canadians and 16/2291 eyes (0.7%) in Caucasian Canadians were diagnosed as having PCV. Indocyanine green angiography (ICGA) was used to diagnose PCV in 20% of Chinese Canadians and 8.8% of Caucasian Canadians. Clinical practices with a larger percentage of Chinese patients were more likely to diagnose PCV in both Chinese (p = 0.004) and Caucasian patients (p = 0.03), were more likely to use photodynamic therapy (PDT) (p < 0.01), and had significantly greater central retinal thickness decrease (p < 0.001). CONCLUSION Our study has shown that PCV is under-recognized in a Canadian population, and ICGA is underutilized. In clinical practices with a greater portion of Chinese patients, PCV is more often recognized and PDT is used more liberally.
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Affiliation(s)
| | - Robert G Devenyi
- Department of Ophthalmology, University of Toronto, Toronto, Ont
| | - Michael H Brent
- Department of Ophthalmology, University of Toronto, Toronto, Ont
| | - Peter J Kertes
- Department of Ophthalmology, University of Toronto, Toronto, Ont
| | - Kenneth T Eng
- Department of Ophthalmology, University of Toronto, Toronto, Ont
| | - Carol E Schwartz
- Department of Ophthalmology, University of Toronto, Toronto, Ont
| | - Radha P Kohly
- Department of Ophthalmology, University of Toronto, Toronto, Ont
| | - David R Chow
- Department of Ophthalmology, University of Toronto, Toronto, Ont
| | - David T Wong
- Department of Ophthalmology, University of Toronto, Toronto, Ont
| | - Alan R Berger
- Department of Ophthalmology, University of Toronto, Toronto, Ont
| | - Fil Altomare
- Department of Ophthalmology, University of Toronto, Toronto, Ont
| | | | - Rajeev H Muni
- Department of Ophthalmology, University of Toronto, Toronto, Ont
| | | | - Patrick Yoo
- University of Melbourne, Melbourne, Australia
| | - Wai-Ching Lam
- Department of Ophthalmology, University of Toronto, Toronto, Ont.
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Baek J, Lee JH, Lee WK. CLINICAL RELEVANCE OF AQUEOUS VASCULAR ENDOTHELIAL GROWTH FACTOR LEVELS IN POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2017; 37:943-950. [PMID: 27617539 DOI: 10.1097/iae.0000000000001284] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate vascular endothelial growth factor (VEGF) level according to the clinical and imaging features, and to explore its relationship with the responsiveness to anti-VEGF treatment in eyes with polypoidal choroidal vasculopathy. METHODS Aqueous samples were collected from 62 eyes of 62 patients with treatment-naïve polypoidal choroidal vasculopathy. Vascular endothelial growth factor levels were measured using enzyme-linked immunosorbent assay. Baseline best-corrected visual acuity, central macular thickness, subfoveal choroidal thickness, greatest linear dimension of the lesion, and the presence of hemorrhage were included in the analysis. The effects of 3 monthly intravitreal ranibizumab injections on best-corrected visual acuity and central macular thickness were assessed. RESULTS Baseline VEGF level was negatively correlated with subfoveal choroidal thickness (r = -0.33, P = 0.01). Other variables had no correlation with VEGF level. The mean change in central macular thickness after anti-VEGF treatment was -51 ± 64 μm, which is positively correlated with VEGF concentration (r = 0.30, P = 0.04) and negatively correlated with subfoveal choroidal thickness (r = -0.35, P = 0.02). CONCLUSION Vascular endothelial growth factor level demonstrated a negative correlation with baseline subfoveal choroidal thickness and was associated with response to anti-VEGF treatment. These findings suggest that VEGF has a variable contribution to the pathogenesis of polypoidal choroidal vasculopathy depending on choroid thickness.
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Affiliation(s)
- Jiwon Baek
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Marques JP, Farinha C, Costa MÂ, Ferrão Â, Nunes S, Silva R. Protocol for a randomised, double-masked, sham-controlled phase 4 study on the efficacy, safety and tolerability of intravitreal aflibercept monotherapy compared with aflibercept with adjunctive photodynamic therapy in polypoidal choroidal vasculopathy: the ATLANTIC study. BMJ Open 2017; 7:e015785. [PMID: 28851779 PMCID: PMC5629716 DOI: 10.1136/bmjopen-2016-015785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The purpose of this study is to compare the efficacy and safety of intravitreal aflibercept (IVA) with sham photodynamic therapy (sPDT) versus IVA with verteporfin PDT (vPDT) in a Caucasian population with treatment-naive polypoidal choroidal vasculopathy (PCV), enrolling into a treat and extend (T&E) regimen. METHODS AND ANALYSIS Randomised, double-masked, sham-controlled, multicentre phase 4 investigator-driven clinical trial. The primary outcomes are (1) change in best-corrected visual acuity (BCVA) from baseline and (2) polyp regression at week 52, assessed by indocyanine green angiography (ICGA). Fifty patients with treatment-naive PCV will be recruited from Portuguese and Spanish clinical sites. Eligible patients will receive monthly IVA for 3 months (week 0, week 4 and week 8). At week 16, all patients will repeat ICGA and undergo central randomisation (1:1 ratio) into one of the following groups: Group 1-IVA T&E + vPDT; Group 2-IVA T&E + sPDT. PDT will be performed at week 16, week 28 and week 40 in the presence of active polyps. After week 16, the presence of macular fluid on optical coherence tomography will determine the schedule of observations. When present, the interval between visits/injections will decrease 2 weeks (minimum 6 weeks). When not, the interval between visits/injections will increase 2 weeks (maximum 12 weeks). Efficacy will be evaluated based on BCVA, central retinal thickness and polyp regression. Safety parameters will include assessment of intraocular pressure, adverse events and serious adverse events. ETHICS AND DISSEMINATION This study was designed and shall be implemented and reported in accordance with the International Conference on Harmonisation (ICH) Harmonised Tripartite Guidelines for Good Clinical Practice, with applicable local regulations and with the ethical principles laid down in the Declaration of Helsinki. The study received approval from Comissão de Ética para a Investigação Clínica and Comité Ético de investigación Clínica del Hospital Universitari de Bellvitge. TRIAL REGISTRATION NUMBER This study is registered under the EudraCT number: 2015-001368-20 and the ClinicalTrials.gov Identifier: NCT02495181.
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Affiliation(s)
- João Pedro Marques
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Cláudia Farinha
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Miguel Ângelo Costa
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Ângela Ferrão
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Sandrina Nunes
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Rufino Silva
- Association for Investigation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
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Submacular hemorrhage and grape-like polyp clusters: factors associated with reactivation of the lesion in polypoidal choroidal vasculopathy. Eye (Lond) 2017; 31:1678-1684. [PMID: 28707675 DOI: 10.1038/eye.2017.126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/10/2017] [Indexed: 01/01/2023] Open
Abstract
PurposeThe purpose of this study is to investigate the factors associated with reactivation of the lesion during the first year in patients with polypoidal choroidal vasculopathy (PCV) treated with intravitreal ranibizumab.Patients and methodsThis retrospective observational study included 84 eyes diagnosed with PCV and treated with 3-monthly ranibizumab injections. Only those patients who exhibited complete resolution of fluid after initial treatment and were followed up at least 12 months were included. The baseline characteristics of the patients, including their age and sex, location of the polyps, greatest linear dimensions of the lesions, largest polyp diameter, choroidal vascular hyperpermeability, submacular hemorrhages ≥1 disc area in size, presence of grape-like polyp clusters, central foveal thickness, and best-corrected visual acuity were compared between patients with and without reactivation of the lesion.ResultsDuring the 12-month follow-up period, reactivation of the lesion was observed in 60 patients (71.4%). The first reactivation was noted at a mean duration of 3.9±1.7 months after the third ranibizumab injection. Cox regression analysis revealed that the absence of submacular hemorrhages ≥1 disc area (P=0.009), presence of grape-like polyp clusters (P=0.002), and greatest linear dimension of the lesions (P=0.019) were associated with reactivation of the lesion.ConclusionThe absence of submacular hemorrhages, presence of grape-like polyp clusters, and large lesion size at diagnosis were associated with a high risk of reactivation of PCV in patients treated with intravitreal ranibizumab. Patients exhibiting these characteristics may require close monitoring.
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Simonett JM, Chan EW, Chou J, Skondra D, Colon D, Chee CK, Lingam G, Fawzi AA. Quantitative Analysis of En Face Spectral-Domain Optical Coherence Tomography Imaging in Polypoidal Choroidal Vasculopathy. Ophthalmic Surg Lasers Imaging Retina 2017; 48:126-133. [PMID: 28195615 DOI: 10.3928/23258160-20170130-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Spectral-domain optical coherence tomography (SD-OCT) imaging can be used to visualize polypoidal choroidal vasculopathy (PCV) lesions in the en face plane. Here, the authors describe a novel lesion quantification technique and compare PCV lesion area measurements and morphology before and after anti-vascular endothelial growth factor (VEGF) treatment. PATIENTS AND METHODS Volumetric SD-OCT scans in eyes with PCV before and after induction anti-VEGF therapy were retrospectively analyzed. En face SD-OCT images were generated and a pixel intensity thresholding process was used to quantify total lesion area. RESULTS Thirteen eyes with PCV were analyzed. En face SD-OCT PCV lesion area quantification showed good intergrader reliability (intraclass correlation coefficient = 0.944). Total PCV lesion area was significantly reduced after anti-VEGF therapy (2.22 mm2 vs. 2.73 mm2; P = .02). The overall geographic pattern of the branching vascular network was typically preserved. CONCLUSION PCV lesion area analysis using en face SD-OCT is a reproducible tool that can quantify treatment related changes. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:126-133.].
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Hikichi T. Six-year outcomes of antivascular endothelial growth factor monotherapy for polypoidal choroidal vasculopathy. Br J Ophthalmol 2017; 102:97-101. [DOI: 10.1136/bjophthalmol-2017-310448] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/20/2017] [Accepted: 04/23/2017] [Indexed: 11/03/2022]
Abstract
ObjectiveTo evaluate the 6-year outcomes of anti-VEGF (vascular endothelial growth factor) monotherapy for polypoidal choroidal vasculopathy (PCV).MethodsThe charts of 66 eyes of 66 patients with newly diagnosed, symptomatic, treatment-naive PCV were reviewed retrospectively. All patients were treated with 0.5 mg intravitreal ranibizumab (IVR) injections for 3 months followed by as-needed reinjections based on monthly examinations until 3 years after the first IVR injection. Thereafter, anti-VEGF monotherapy was continued for another 3 years.ResultsThe mean best-corrected visual acuity (BCVA) improved significantly (p=0.001) 3 months after the first IVR injection (0.24±0.30 logarithm of the minimum angle of resolution (logMAR) VA; 20/35 Snellen VA) compared with the baseline BCVA (0.34±0.37 logMAR VA; 20/44 Snellen VA). However, the improved VA returned to 0.32±0.39 logMAR unit (20/42 Snellen VA), which was not significantly different at 3 years. This level was maintained to the end of 6 years (0.36±0.37 logMAR unit; 20/46 Snellen VA). The mean numbers of anti-VEGF injections administered annually during 6 years were 5.6±2.4 (including the initial three monthly injections), 3.3±2.2, 3.3±2.9, 3.6±3.2, 3.5±2.9 and 3.3±2.7, respectively. The mean total number of injections during 6 years was 21.5±10.1.ConclusionsThe results emphasised the efficacy of anti-VEGF therapy for preserving vision and the limitations of anti-VEGF therapy in that continuous treatment is required over an extended follow-up period.
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Hwang HJ, Kim JH, Chang YS, Kim JW, Kim CG. Polypoidal Choroidal Vasculopathy with Feeder Vessels: Characteristics, Fellow Eye Findings, and Long-term Treatment Outcomes. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:230-239. [PMID: 28534339 PMCID: PMC5469926 DOI: 10.3341/kjo.2016.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/27/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the long-term outcomes of anti-vascular endothelial growth factor (VEGF) therapy for polypoidal choroidal vasculopathy (PCV) with feeder vessels and to investigate fellow-eye findings. METHODS This retrospective observational study included 14 eyes with treatment-naïve PCV accompanied by feeder vessels that were treated with anti-VEGF monotherapy. The best-corrected visual acuity (BCVA) at baseline was compared with that at the last follow-up. The fellow-eye indocyanine green angiography findings were also analyzed. RESULTS The mean follow-up period was 28.1 ± 19.2 months (range, 12 to 60 months). During the follow-up period, 5.9 ± 2.5 anti-VEGF injections were administered. The logarithm of the minimal angle of resolution (logMAR) BCVAs at the time of diagnosis, at 3 months, and at the last follow-up were 0.81 ± 0.49, 0.55 ± 0.44, and 0.71 ± 0.54, respectively. Although the BCVA at the last follow-up was not different from the baseline value (p=0.809), an improvement of ≥0.2 logMAR BCVA was observed in seven eyes (50.0%). In 11 eyes that underwent bilateral indocyanine green angiography at diagnosis, PCV, branching vascular networks, and late geographic hyperfluorescence were noted in two (18.2%), five (45.4%), and three (27.3%) fellow eyes, respectively. During the follow-up period, the development of polypoidal lesions in the fellow eye was observed in three patients. CONCLUSIONS In this study, long-term improvement in BCVA was noted in 50% of the included patients who received anti-VEGF monotherapy. A relatively high incidence of pathological findings in the fellow eye and bilateral involvement suggest the need for bilateral examinations.
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Affiliation(s)
- Hyun Ji Hwang
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea.
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Characteristics of Submacular Hemorrhages in Age-Related Macular Degeneration. Optom Vis Sci 2017; 94:556-563. [DOI: 10.1097/opx.0000000000001066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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ANGIOGRAPHIC FINDINGS OF RANIBIZUMAB-RESISTANT POLYPOIDAL CHOROIDAL VASCULOPATHY AFTER SWITCHING TO A TREAT-AND-EXTEND REGIMEN WITH INTRAVITREAL AFLIBERCEPT. Retina 2017; 36:2158-2165. [PMID: 27258669 DOI: 10.1097/iae.0000000000001047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to study the angiopathic findings of ranibizumab-resistant polypoidal choroidal vasculopathy after switching to a treat-and-extend regimen with intravitreal aflibercept. METHODS The authors retrospectively reviewed 17 eyes of 17 Japanese patients with polypoidal choroidal vasculopathy (10 men and 7 women, age: 73.8 ± 7.4 years) who were treated with intravitreal aflibercept (2 mg/0.05 mL) injections from February 2013 to August 2014 at Tokyo University Hospital. All patients had switched to aflibercept because their polypoidal choroidal vasculopathy had been refractory to ranibizumab. RESULTS The mean logMAR best-corrected visual acuity at baseline and after 12 months of therapy was 0.30 ± 0.29 (Snellen equivalent: 20/40) and 0.17 ± 0.26 (20/30) (paired t-test P < 0.001). Visual acuity remained stable in 5 cases (29%), deteriorated in 3 (18%), and improved in 9 (53%). Branching vascular networks persisted in all 17 eyes but shrank in 15 (88%). The mean lesion diameter was 3329 ± 1261 μm at baseline and 3180 ± 1247 μm after 12 months (P = 0.0002). CONCLUSION A treat-and-extend regimen with intravitreal aflibercept for ranibizumab-resistant patients resulted in branching vascular network shrinkage over a 1-year period.
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EFFICACY OF INTRAVITREAL INJECTION OF CONBERCEPT IN POLYPOIDAL CHOROIDAL VASCULOPATHY: Subgroup Analysis of the Aurora Study. Retina 2016; 36:926-37. [PMID: 26595362 DOI: 10.1097/iae.0000000000000875] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the efficacy of different doses of conbercept in patients with polypoidal choroidal vasculopathy in the AURORA study. METHODS Retrospective subgroup analyses of 12-month data from the AURORA study. Fifty-three patients (32 in 0.5-mg group and 21 in 2.0-mg group) diagnosed with polypoidal choroidal vasculopathy in AURORA study were retrospectively evaluated. Efficacy outcomes were compared between the two dosage groups. RESULTS At Month 12, mean changes in best-corrected visual acuity from baseline were 14.4 ± 14.1 letter scores for the 0.5-mg group and 14.2 ± 21.0 letter scores for the 2.0-mg group; mean central retinal thickness decreased by 104.5 ± 127.3 μm in the 0.5-mg group and 140.7 ± 127.9 μm in the 2.0-mg group; mean total macular volume decreased by 0.9 ± 2.3 mm and 1.0 ± 1.2 mm in the 0.5-mg and 2.0-mg groups, respectively. The mean subretinal fluid thickness decreased by 111.9 ± 122.5 μm and 76.3 ± 112.6 μm in the 0.5-mg and 2.0-mg groups, respectively. The mean pigment epithelial detachment height decreased by 79.3 ± 217.8 μm and 61.3 ± 161.5 μm in the 0.5-mg and 2.0-mg groups, respectively. The mean area of polyps decreased by 0.46 ± 0.76 mm and 0.55 ± 1.34 mm in the 0.5-mg and 2.0-mg groups, respectively. The mean total lesion area decreased by 2.51 ± 5.94 mm (P = 0.088) and 4.62 ± 5.51 mm in the 0.5-mg group and 2.0-mg groups, respectively. Complete regression of polyps was observed in 56.5% of patients in the 0.5-mg group and 52.9% of those in the 2.0-mg group, whereas partial regression was observed in 26.1% and 35.3% of patients in the 0.5-mg and 2.0-mg groups, respectively. CONCLUSION Intravitreal injection of conbercept appears to significantly improve visual acuity and anatomical outcomes in patients with polypoidal choroidal vasculopathy.
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Treatment of polypoidal choroidal vasculopathy by photodynamic therapy, aflibercept and dexamethasone triple therapy. Sci Rep 2016; 6:36870. [PMID: 27848983 PMCID: PMC5111116 DOI: 10.1038/srep36870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/21/2016] [Indexed: 12/27/2022] Open
Abstract
Polypoidal choroidal vasculopathy is a relatively common type of degenerative macular disease among the Chinese population. This study aims to describe the therapeutic responses to combination therapy with photodynamic therapy, intravitreal aflibercept and intravitreal dexamethasone in patients with polypoidal choroidal vasculopathy. A prospective series of 17 eyes of 13 patients suffering from treatment-naïve polypoidal choroidal vasculoapathy were recruited. All cases received triple therapy with photodynamic therapy, intravitreal aflibercept and intravitreal dexamethasone and one year outcomes were reported. The baseline visual acuity was 0.65logMAR +/- 0.38 (Snellen 20/80 to 20/100). The visual acuity at 1 week, 3 months, 6 months and one year after treatment were significantly improved to 0.522logMAR+/- 0.365 (P < 0.04) (Snellen 20/70), 0.363logMAR+/-0.382 (Snellen 20/50;P < 0.001), 0.377logMAR +/- 0.440 (Snellen 20/50;p = 0.005), and 0.35logMAR +/- 0.407 (Snellen 20/40;P < 0.001), respectively. The baseline central foveal thickness (CFT) on optical coherence tomography (OCT) was 394.7 +/- 70.6 μm. CFT at 6 months and 1 year after treatment were significantly reduced to 259 +/- 54 μm (p = 0.004) and 271 +/- 49.7 μm(p = 0.016), respectively. Triple therapy with photodynamic therapy, intravitreal aflibercept and intravitreal dexamethasone is an effective treatment for polypoidal choroidal vasculopathy. The majority of cases responded well with significant responses observed as early as 1 week after initiation of therapy.
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One-year outcome of combination therapy with intravitreal aflibercept and verteporfin photodynamic therapy for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2016; 255:541-548. [PMID: 27687988 DOI: 10.1007/s00417-016-3500-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/12/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The purpose of the study was to evaluate the 1-year visual and anatomical outcomes of combination therapy with intravitreal aflibercept (IVA) and verteporfin photodynamic therapy (vPDT) for polypoidal choroidal vasculopathy (PCV), and to determine the predictors of a good visual outcome. METHODS This was a prospective case-series study. Twenty eyes from 20 treatment-naïve PCV patients were treated with combination therapy with IVA and vPDT. Best-corrected visual acuity (BCVA) and morphological parameters including polypoidal lesions in indocyanine green angiography (ICGA) were evaluated over 12 months of follow-up. RESULTS The mean logMAR BCVA was significantly improved from 0.30 at baseline to 0.20 at 3 months and 0.18 at 12 months. The mean central retinal thickness was also significantly improved at 3 months and at 12 months. In ICGA, complete regression of polypoidal lesions was found in 14 out of 20 eyes (70 %) at 3 months and in 14 out of 18 eyes (78 %) at 12 months although no ICGA were done on two eyes. In the multivariate logistic regression analyses, the baseline greatest linear dimension was found as a significant predictive factor for good visual improvement (≧0.3 LogMAR units improvement from baseline) at 12 months. CONCLUSION In this study, combination therapy with IVA and vPDT gave visual and anatomical improvements to treatment-naïve PCV patients over 12 months of follow-up period.
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Lee JE, Shin JP, Kim HW, Chang W, Kim YC, Lee SJ, Chung IY, Lee JE. Efficacy of fixed-dosing aflibercept for treating polypoidal choroidal vasculopathy: 1-year results of the VAULT study. Graefes Arch Clin Exp Ophthalmol 2016; 255:493-502. [PMID: 27628062 PMCID: PMC5323470 DOI: 10.1007/s00417-016-3489-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/18/2016] [Accepted: 08/25/2016] [Indexed: 12/27/2022] Open
Abstract
Purpose To investigate fixed-dosing aflibercept for treating polypoidal choroidal vasculopathy (PCV). Methods This phase IV, prospective, single-arm, interventional case series was conducted in eight centers. Forty treatment-naïve PCV patients were administered three monthly doses of intravitreal aflibercept (2.0 mg) and an injection every 2 months thereafter. Best-corrected visual acuity (BCVA) and central subfield macular thickness (CSMT) were measured at each visit. Fluorescein and indocyanine green angiography (ICGA) were performed at baseline, 3 and 12 months. The primary outcome measure was the proportion of patients who maintained BCVA (<15 letters loss) at 12 months. Changes in BCVA, macular appearance, and polypoidal lesion appearance were also examined. Results Thirty-five eyes (87.5 %) had maintained BCVA at 12 months. Average BCVA was significantly higher at 12 months (20/53, 64.2 letters) than at baseline (20/80, 55.1 letters, 9-letter gain; P < .001). Mean CSMT was significantly lower at 12 months (253.6 μm) than at baseline (365.2 μm, P < .001). The macula was dry in 32 (76.2 %), 27 (64.3 %), and 24 eyes (60.0 %) at 3, 6, and 12 months respectively. Fourteen eyes (33.3 %) had a fluid recurrence or increase at 6 months, and they had a significantly lower vision gain (P = .005) than other patients at 12 months. Complete polyp regression occurred in 26 eyes (66.7 %) at 12 months. Conclusions Fixed-dosing aflibercept showed favorable outcomes in PCV patients at 12 months. However, some patients had worse outcomes because of fluid recurrence during maintenance dosing, and these patients would require additional treatments.
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Affiliation(s)
- Joo Eun Lee
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jae Pil Shin
- Department of Ophthalmology, Kyungpook National University Hospital, Deagu, South Korea
| | - Hyun Woong Kim
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Woohyok Chang
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea.,Chang's Retina Center, Daegu, South Korea
| | - Yu Cheol Kim
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Sang Joon Lee
- Department of Ophthalmology, College of Medicine and Institute of Medicine, Kosin University, Busan, South Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan, 602-739, South Korea. .,Department of Ophthalmology, College of Medicine, Pusan National University, Yangsan, South Korea. .,Biomedical Research Institute, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan, 602-739, South Korea.
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Agarwal A, Aggarwal K, Gupta V. Management of Neovascular Age-related Macular Degeneration: A Review on Landmark Randomized Controlled Trials. Middle East Afr J Ophthalmol 2016; 23:27-37. [PMID: 26957836 PMCID: PMC4759900 DOI: 10.4103/0974-9233.173133] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In the last decade, a number of prospective clinical trials with carefully designed study protocols have been conducted for the treatment of neovascular age-related macular degeneration (AMD). These landmark clinical trials such as ANCHOR and MARINA and, more recently, the Comparison of AMD Treatment Trials and VIEW studies have revolutionized the management of neovascular AMD. While AMD continues to remain a leading cause of severe visual loss worldwide, advances in pharmacotherapeutics have led to substantial improvements in the outcome of these patients. The introduction of anti-vascular endothelial growth factor agents has resulted in improvement of visual outcomes and has had a positive impact on the quality of life among elderly population. While the contemporary management of neovascular AMD has been successful in tremendously reducing the visual morbidity, the financial burden of therapy has increased exponentially. To overcome these challenges, newer pharmacologic agents are evaluated for their efficacy and safety in AMD. Ground-breaking advances in bench to bedside research have led to discovery of new pathways that appear to be viable targets for preventing visual loss in AMD. In this review, study designs and results of landmark clinical trials in AMD from the past decade have been summarized.
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Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kanika Aggarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Chang YS, Kim JH, Kim JW, Lee TG, Kim CG. Intravitreal Anti-vascular Endothelial Growth Factor for Treating Polypoidal Choroidal Vasculopathy with Grape-like Polyp Clusters. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:272-9. [PMID: 27478354 PMCID: PMC4965602 DOI: 10.3341/kjo.2016.30.4.272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/31/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate 12-month outcomes of anti-vascular endothelial growth factor (VEGF) therapy for polypoidal choroidal vasculopathy (PCV) with grape-like polyp clusters. Methods This retrospective observational study included 23 eyes of 23 patients who were newly diagnosed with PCV with grape-like polyp clusters, and who were subsequently treated with anti-VEGF monotherapy. The study compares the best-corrected visual acuity (BCVA) of the patients at diagnosis, at 3 months, and at 12 months after diagnosis. In addition, 12-month changes in BCVA values were compared between cases with subfoveal or juxtafoveal polyps and cases with extrafoveal polyps. Results The baseline, 3-month, and 12-month logarithm of the minimal angle of resolution BCVA was 0.62 ± 0.35, 0.50 ± 0.43, and 0.58 ± 0.48, respectively. Compared to the baseline, patient BCVA was not significantly different at 12 months after diagnosis (p = 0.764). Six eyes (26.1%) gained ≥0.2 logarithm of the minimal angle of resolution BCVA. In cases with subfoveal or juxtafoveal polyps, BCVA values at baseline and at 12 months after diagnosis were 0.66 ± 0.37 and 0.69 ± 0.53, respectively. In cases with extrafoveal polyps, the values were 0.54 ± 0.33 and 0.37 ± 0.31, respectively. Changes in BCVA values were significantly different between the two groups (p = 0.023). Conclusions Although anti-VEGF therapy has favorable short-term efficacy for treating PCV with grape-like polyp clusters, long-term visual improvements are generally limited in the majority of afflicted eyes. The presence of subfoveal or juxtafoveal polyps may suggest unfavorable treatment outcomes.
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Affiliation(s)
- Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Tae Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Kokame GT, Lai JC, Wee R, Yanagihara R, Shantha JG, Ayabe J, Hirai K. Prospective clinical trial of Intravitreal aflibercept treatment for PolypoIdal choroidal vasculopathy with hemorrhage or exudation (EPIC study): 6 month results. BMC Ophthalmol 2016; 16:127. [PMID: 27465105 PMCID: PMC4964097 DOI: 10.1186/s12886-016-0305-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/18/2016] [Indexed: 12/03/2022] Open
Abstract
Background Polypoidal choroidal vasculopathy is a variant of choroidal neovascularization and neovascular age related macular degeneration presenting with hemorrhagic and exudative changes within the macula and/or peripapillary region leading to vision loss. In contrast to neovascular age related macular degeneration, polypoidal choroidal vasculopathy has differing clinical manifestations and treatment strategies. Historically, polypoidal choroidal vasculopathy complexes are less responsive to anti-vascular endothelial growth factor therapy with no prospective clinical trials evaluating aflibercept in management of polypoidal choroidal vasculopathy. Herein we prospectively evaluate the efficacy and safety of intravitreal aflibercept in polypoidal choroidal vasculopathy. Methods A prospective, open-label, investigator-sponsored trial of intravitreal aflibercept for polypoidal choroidal vasculopathy in 21 eyes was conducted. Injections were administered monthly for 3 initial treatments, then every other month with monthly evaluations. The primary outcome measures were the mean change in best corrected visual acuity and adverse events. Secondary outcome measures included stabilization of vision, presence of subretinal hemorrhage, serous detachment, retinal pigment epithelial detachment, and regression of polypoidal complexes on indocyanine green angiography. Results At 6 months, the median visual acuity was 20/40 (range 20/25–20/200) with a mean Early Treatment Diabetic Retinopathy Study vision of 68.4 letters. There was a gain of 2.76 Early Treatment Diabetic Retinopathy Study letters at 6 months (p = 0.15). No patient developed severe vision loss (≤15 letters) and vision was stable or improved in 19/21 eyes (91 %). Subretinal fluid resolved in 13/18 eyes (72 %), and subretinal hemorrhage resolved in 6/8 eyes (75 %) respectively. The polyps regressed in 14/21 eyes (67 %) and the branching vascular network decreased in 1 eye and was stable in all other eyes. The retinal pigment epithelial detachment improved in 13/15 eyes (87 %). Bimonthly treatment occurred in 15/21 patients (71 %). There were no adverse events. Conclusions Intravitreal aflibercept results in stabilization of vision, resolution of exudative and hemorrhagic complications with regression of polyps in polypoidal choroidal vasculopathy. Eyes with polypoidal choroidal vasculopathy previously treated with ranibizumab and bevacizumab can show marked improvement in the retinal pigment epithelial detachments and persistent polyps with aflibercept therapy. Trial registration Clinical trials.gov NCT01871376, June 4th 2013 Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0305-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gregg T Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, 651 IIalo St, Honolulu, HI, 96813, USA. .,The Retina Center at Pali Momi, 98-1079 Moanalua Road, Suite 470, Aiea, Hawaii, 96701, USA. .,Retina Consultants of Hawaii, 1380 Lusitana St #506, Honolulu, HI, 96813, USA. .,Hawaii Macula and Retina Institute, 98-1079 Moanalua Road, Suite 470, Aiea, Hawaii, 96701, USA.
| | - James C Lai
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, 651 IIalo St, Honolulu, HI, 96813, USA.,The Retina Center at Pali Momi, 98-1079 Moanalua Road, Suite 470, Aiea, Hawaii, 96701, USA.,Retina Consultants of Hawaii, 1380 Lusitana St #506, Honolulu, HI, 96813, USA.,Hawaii Macula and Retina Institute, 98-1079 Moanalua Road, Suite 470, Aiea, Hawaii, 96701, USA
| | - Raymond Wee
- The Retina Center at Pali Momi, 98-1079 Moanalua Road, Suite 470, Aiea, Hawaii, 96701, USA.,Retina Consultants of Hawaii, 1380 Lusitana St #506, Honolulu, HI, 96813, USA.,Hawaii Macula and Retina Institute, 98-1079 Moanalua Road, Suite 470, Aiea, Hawaii, 96701, USA
| | - Ryan Yanagihara
- The Retina Center at Pali Momi, 98-1079 Moanalua Road, Suite 470, Aiea, Hawaii, 96701, USA.,Retina Consultants of Hawaii, 1380 Lusitana St #506, Honolulu, HI, 96813, USA.,Hawaii Macula and Retina Institute, 98-1079 Moanalua Road, Suite 470, Aiea, Hawaii, 96701, USA.,John A. Burns School of Medicine, University of Hawaii School of Medicine, 651 Ilalo St, Honolulu, HI, 96813, USA
| | - Jessica G Shantha
- The Retina Center at Pali Momi, 98-1079 Moanalua Road, Suite 470, Aiea, Hawaii, 96701, USA.,Retina Consultants of Hawaii, 1380 Lusitana St #506, Honolulu, HI, 96813, USA.,Hawaii Macula and Retina Institute, 98-1079 Moanalua Road, Suite 470, Aiea, Hawaii, 96701, USA
| | - Julia Ayabe
- John A. Burns School of Medicine, University of Hawaii School of Medicine, 651 Ilalo St, Honolulu, HI, 96813, USA
| | - Kelsi Hirai
- John A. Burns School of Medicine, University of Hawaii School of Medicine, 651 Ilalo St, Honolulu, HI, 96813, USA
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Shin MK, Lee JE, Byon IS, Park SW. Choroidal Watershed Zone and Growth of Polypoidal Choroidal Vasculopathy. Curr Eye Res 2016; 42:252-259. [PMID: 27400136 DOI: 10.1080/02713683.2016.1183794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the topographic relationship between polypoidal choroidal vasculopathy (PCV) growth and choroidal watershed zones (CWZ) by using indocyanine green angiography (ICGA). MATERIALS AND METHODS We evaluated PCV lesions smaller than the CWZ at baseline and followed up more than 6 months. The CWZ was traced in the early phase ICGA at baseline. The vascular lesion of PCV was traced in baseline and follow-up ICGA. These traces were overlapped and topographic relationships between CWZs and PCV growth were evaluated. RESULTS Among 31 eyes of 31 patients, enlargement of a PCV lesion was observed in 20 patients (64.5%) at mean follow-up of 30.4 months (6-68 months). A topographical relationship between the CWZ and PCV growth was demonstrated in 14 eyes (70.0%), as the shape of the PCV lesion conformed to the boundary of the CWZ, and/or the growth of the branching vascular network was aligned to the direction of the CWZ extension to the periphery. Growth beyond the boundary of the CWZ was noted in 9 eyes (45.0%), however growth area was greater inside the CWZ than outside in all eyes. Of 15 eyes of extrafoveal lesion at baseline, 8 eyes in which the vascular lesion progressed to the fovea had the CWZ involving the fovea, whereas PCV in three eyes with an extrafoveal CWZ remained as a non-subfoveal disease after mean follow-up of 17.0 months (p = 0.019). CONCLUSIONS A subfoveal CWZ was related to PCV growth to the fovea. Topographical relationships between PCV growth and the CWZ suggest that choroidal circulation is a predisposition for PCV growth.
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Affiliation(s)
- Min Kyu Shin
- a Department of Ophthalmology , College of Medicine, Pusan National University , Yangsan , Korea
| | - Ji Eun Lee
- a Department of Ophthalmology , College of Medicine, Pusan National University , Yangsan , Korea.,b Medical Research Institute, Pusan National University Hospital , Busan , Korea
| | - Ik Soo Byon
- a Department of Ophthalmology , College of Medicine, Pusan National University , Yangsan , Korea.,c Research Institute for Convergence of Biomedical Science and Technology , Pusan National University Yangsan Hospital , Yangsan , Korea
| | - Sung Who Park
- a Department of Ophthalmology , College of Medicine, Pusan National University , Yangsan , Korea.,b Medical Research Institute, Pusan National University Hospital , Busan , Korea
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79
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Chang YS, Kim JH, Kim JW, Lee TG, Kim CG. Optical Coherence Tomography-based Diagnosis of Polypoidal Choroidal Vasculopathy in Korean Patients. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:198-205. [PMID: 27247519 PMCID: PMC4878980 DOI: 10.3341/kjo.2016.30.3.198] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/15/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy of an optical coherence tomography (OCT)-based diagnosis of polypoidal choroidal vasculopathy (PCV) in Korean patients. Methods This retrospective, observational case series included 263 eyes of 263 patients (147 eyes with PCV and 116 eyes with typical exudative, age-related macular degeneration [AMD]) who had been diagnosed with treatment naïve exudative AMD. Eyes with three or more of the following OCT findings were diagnosed with PCV: multiple retinal pigment epithelial detachment (RPED), a sharp RPED peak, an RPED notch, a hyporeflective lumen representing polyps, and hyperreflective intraretinal hard exudates. The OCT-based diagnosis was compared with the gold-standard indocyanine green angiography-based method. The sensitivity and specificity of the OCT-based diagnosis was also estimated. An additional analysis was performed using a choroidal thickness criterion. Eyes with a subfoveal choroidal thickness greater than 300 µm were also diagnosed with PCV despite having only two OCT features. Results In eyes with PCV, three or more OCT features were observed in 126 of 147 eyes (85.7%), and the incidence of typical exudative AMD was 16 of 116 eyes (13.8%). The sensitivity and specificity of an OCT-based diagnosis were 85.7% and 86.2%, respectively. After applying the choroidal thickness criterion, the sensitivity increased from 85.7% to 89.8%, and the specificity decreased from 86.2% to 84.5%. Conclusions The OCT-based diagnosis of PCV showed a high sensitivity and specificity in Korean patients. The addition of a choroidal thickness criterion improved the sensitivity of the method with a minimal decrease in its specificity.
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Affiliation(s)
- Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Tae Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
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80
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Bialasiewicz AA, Abdelhamid M, Shenoy R, Barman M. Long-term Resolution of Blinding Polypoidal Choroidal Vasculopathy with Recurrent Bilateral Central Involvement by Low-dose Oral Eplerenone Treatment. Middle East Afr J Ophthalmol 2016; 23:225-8. [PMID: 27162459 PMCID: PMC4845625 DOI: 10.4103/0974-9233.175894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 55-year-old male presented with serous retinal detachment over 3 months in his right eye. His left eye was blind due to retinal pigment epithelium detachment since 1997 with atrophy of the neurosensory retina. Fluorescein angiography had previously shown bilateral polypoidal choroidal vasculopathy (PCV). Optical coherence tomography (OCT) confirmed PCV with central involvement. The patient underwent intravitreal injections of 6x Lucentis, 4x Avastin and one injection of aflibercept. PCV recurred from 1 to 4 months after each treatment. The patient had history of stroke, hypertension, and atrial fibrillation and was started on oral eplerenone 25 mg/day in October 2014, which resulted in a long-term ongoing complete retinal reattachment. OCT ganglion cell and inner plexiform layers showed full recovery of the fovea in the right eye and irreversible in the left eye. Low-dose eplerenone may resolve recalcitrant PCV with central involvement. The duration of treatment remains uncertain.
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Affiliation(s)
| | | | - Radha Shenoy
- Department of Ophthalmology, Armed Forces Hospital, Muscat, Qatar
| | - Manish Barman
- Department of Cardiology, Al-Ahli Hospital, Doha, Qatar, Qatar
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81
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Tan CS, Ngo WK, Lim LW, Tan NW, Lim TH. EVEREST study report 3: diagnostic challenges of polypoidal choroidal vasculopathy. Lessons learnt from screening failures in the EVEREST study. Graefes Arch Clin Exp Ophthalmol 2016; 254:1923-1930. [PMID: 27142805 PMCID: PMC5045476 DOI: 10.1007/s00417-016-3333-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/26/2016] [Accepted: 03/28/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose To describe screening failures in the EVEREST study by examining the imaging characteristics that enabled differentiation of polypoidal choroidal vasculopathy (PCV) from cases that were subsequently diagnosed not to be PCV. Methods Post-hoc analysis of 34 patients with PCV reported as screening failures from EVEREST study. Standardised confocal scanning laser indocyanine green angiography (ICGA) images were graded by the Central Reading Centre to confirm PCV diagnosis based on the presence of early focal sub-retinal hyperfluorescence on ICGA and at least one of the following six diagnostic criteria: (1) nodular appearance of polyp(s) on stereoscopic examination, (2) hypofluorescent halo around nodule(s), (3) presence of a branching vascular network, (4) pulsation of polyp(s) on dynamic ICGA, (5) orange sub-retinal nodules on colour fundus photography, or (6) massive sub-macular haemorrhage (≥4 disc areas in size). Additional detailed image grading was performed with stereo-imaging and dynamic early-phase ICGA. Results Of the 95 screened PCV cases, 34 were excluded: (1) cases not suitable for recruitment as per the study protocol (n = 14), (2) equivocal lesions on ICGA characterised by small hyperfluorescent dots (n = 9), and (3) cases that were definitely not PCV (non-PCV, n = 11), identified by definitive diagnoses which included one case each of micro-aneurysm, retinal angiomatous proliferation, retino-choroidal anastomosis, small type-2 choroidal neovascularisation, retinal pigment epithelial (RPE) window defect and disciform scar; two cases of lesions where the choroidal vessel changed its course; and three cases of late-onset RPE staining. Conclusions Standardised image grading techniques used in EVEREST study enabled effective differentiation of non-PCV from actual PCV. Electronic supplementary material The online version of this article (doi:10.1007/s00417-016-3333-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colin S Tan
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Wei Kiong Ngo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Louis W Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Nikolle W Tan
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Tock H Lim
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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82
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Chang YS, Kim JH, Kim KM, Kim JW, Lee TG, Kim CG, Cho SW. Long-Term Outcomes of Anti-Vascular Endothelial Growth Factor Therapy for Polypoidal Choroidal Vasculopathy. J Ocul Pharmacol Ther 2016; 32:219-24. [DOI: 10.1089/jop.2015.0073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Kyung Min Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Tae Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Sung Won Cho
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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83
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Wong CW, Yanagi Y, Lee WK, Ogura Y, Yeo I, Wong TY, Cheung CMG. Age-related macular degeneration and polypoidal choroidal vasculopathy in Asians. Prog Retin Eye Res 2016; 53:107-139. [PMID: 27094371 DOI: 10.1016/j.preteyeres.2016.04.002] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 12/12/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in elderly people globally. It is estimated that there will be more Asians with AMD than the rest of the world combined by 2050. In Asian populations, polypoidal choroidal vasculopathy (PCV) is a common subtype of exudative AMD, while choroidal neovascularization secondary to AMD (CNV-AMD) is the typical subtype in Western populations. The two subtypes share many common clinical features and risk factors, but also have different epidemiological and clinical characteristics, natural history and treatment outcomes that point to distinct pathophysiological processes. Recent research in the fields of genetics, proteomics and imaging has provided further clarification of differences between PCV and CNV-AMD. Importantly, these differences have manifested as disparity in response to intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) treatment between PCV and CNV-AMD, emphasizing the need for accurate diagnosis of PCV and in distinguishing PCV from CNV-AMD, particularly in Asian patients. Current clinical trials of intravitreal anti-VEGF therapy and photodynamic therapy will provide clearer perspectives of evidence-based management of PCV and may lead to paradigm shifts in therapeutic strategies away from those currently employed in the treatment of CNV-AMD. Further research is needed to clarify the relative contribution of specific pathways in inflammation, complement activation, extracellular matrix dysregulation, lipid metabolism and angiogenesis to the pathogenesis of PCV. Findings from this research, together with improved diagnostic technology and new therapeutics, will facilitate more optimal management of Asian AMD.
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Affiliation(s)
- Chee Wai Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Yasuo Yanagi
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Won-Ki Lee
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yuichiro Ogura
- Department of Ophthalmology, Nagoya City University, Nagoya, Japan
| | - Ian Yeo
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
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84
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Kim JH, Lee TG, Chang YS, Kim CG, Cho SW. Short-term choroidal thickness changes in patients treated with either ranibizumab or aflibercept: a comparative study. Br J Ophthalmol 2016; 100:1634-1639. [PMID: 26951770 DOI: 10.1136/bjophthalmol-2015-308074] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/07/2016] [Accepted: 02/10/2016] [Indexed: 11/04/2022]
Abstract
PURPOSE To compare, in neovascular age-related macular degeneration (AMD) patients, short-term choroidal thickness changes in eyes treated using ranibizumab with those in eyes treated using aflibercept. METHODS This retrospective, observational study included 240 eyes from 240 patients who had been diagnosed with treatment-naive neovascular AMD and treated using three monthly injections of either ranibizumab (ranibizumab group) or aflibercept (aflibercept group). The choroidal thickness change between the time of diagnosis and 3 months later was compared between the two groups. Eyes were then classified into three disease groups: typical neovascular AMD, polypoidal choroidal vasculopathy (PCV) and retinal angiomatous proliferation (RAP). Within each disease group, choroidal thickness change was again compared between the two treatment groups. RESULTS In the ranibizumab group (n=155), the mean choroidal thicknesses at diagnosis and at 3 months were 255.3±103.9 μm and 242.9±104.8 μm, respectively. In the aflibercept group (n=85), the values were 277.5±119.1 μm and 254.7±114.5 μm, respectively. The decrease was significantly greater in the aflibercept group (p<0.001). In the PCV group, the decrease was greater in the aflibercept group (p=0.001), whereas the difference was not significant in either the typical neovascular AMD group or the RAP group. CONCLUSIONS A greater decrease in choroidal thickness was noted in eyes treated with aflibercept than in eyes treated with ranibizumab. This difference was more marked in PCV than in other subtypes of neovascular AMD.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Tae Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Sung Won Cho
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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85
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Kang HM, Koh HJ, Lee SC. Baseline polyp size as a potential predictive factor for recurrence of polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2015; 254:1519-1527. [PMID: 26686373 DOI: 10.1007/s00417-015-3241-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 11/17/2015] [Accepted: 12/01/2015] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To investigate the predictive factors for recurrence of polypoidal choroidal vasculopathy (PCV). METHODS The medical records of 78 consecutive patients (78 eyes) with treatment-naïve PCV who responded to first-line treatment and completed at least a 3-year follow-up after the first remission were retrospectively analyzed. In this comparative cohort study, baseline characteristics were compared between the patients who had at least one recurrence (the recurrence group) and those without recurrence (the non-recurrence group) during at least 3-year follow-up periods. In addition, possible predictive factors for recurrence of PCV were investigated by using Cox regression analysis. RESULTS Within 3 years of the first remission, 50 eyes (64 %) showed at least one recurrence (mean 1.5; 1 to ∼2 times). There were no significant differences in the baseline characteristics between the recurrence group and the non-recurrence group. However, the largest polyp diameter was significantly different: the mean largest polyp diameter (524 ± 340 μm) was significantly larger in the recurrence group compared to that of the non-recurrence group (352 ± 173 μm; P = 0.038). Cox regression analysis showed that the largest polyp diameter at baseline significantly correlated with recurrence of PCV (B = 1.470, P = 0.015). CONCLUSIONS The largest polyp diameter at baseline may be predictive for PCV recurrence, as it was significantly larger in patients who had at least one recurrence.
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Affiliation(s)
- Hae Min Kang
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, 120-752, Republic of Korea.,Department of Ophthalmology, Catholic Kwandong Universtiy College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Hyoung Jun Koh
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, 120-752, Republic of Korea
| | - Sung Chul Lee
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, 120-752, Republic of Korea.
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86
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Kim JH, Lee DW, Choi SC, Kim JW, Lee TG, Kim CG, Cho HJ. Intravitreal Anti-vascular Endothelial Growth Factor for Newly Diagnosed Symptomatic Polypoidal Choroidal Vasculopathy with Extrafoveal Polyps. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:404-10. [PMID: 26635457 PMCID: PMC4668256 DOI: 10.3341/kjo.2015.29.6.404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 05/06/2015] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the 12-month outcome of anti-vascular endothelial growth factor (VEGF) treatment for extrafoveal polypoidal choroidal vasculopathy (PCV). METHODS This retrospective observational study included 32 eyes of 32 patients newly diagnosed with extrafoveal PCV (polyps located more than 500 µm from the center of the fovea). Patients were treated with intravitreal ranibizumab, bevacizumab, or both. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) at diagnosis and at 12 months were compared. Eyes were divided into two groups according to the presence of submacular hemorrhage. The BCVA in each group was compared at baseline and at 12 months. RESULTS During the 12-month study period, patients received an average of 4.0 ± 1.1 anti-VEGF injections. The BCVA at baseline, three-month post-diagnosis, and 12-month post-diagnosis was 0.59 ± 0.40, 0.34 ± 0.38, and 0.38 ± 0.38, respectively. The BCVA at 12 months was significantly better than the baseline value (p = 0.002). The CFT at baseline, three-month, and 12-month post-diagnosis was 477.1 ± 194.2 µm, 214.5 ± 108.8 µm, and 229.8 ± 106.1 µm, respectively. The CFT at 12 months was significantly lower than the baseline value (p < 0.001). A significant improvement in BCVA was noted in eyes with and without submacular hemorrhage (n = 13, p = 0.032 and n = 19, p = 0.007, respectively). CONCLUSIONS Anti-VEGF therapy was beneficial in extrafoveal PCV, regardless of the presence of submacular hemorrhage.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Sung Chan Choi
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Tae Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Han Joo Cho
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Tang K, Si JK, Guo DD, Cui Y, Du YX, Pan XM, Bi HS. Ranibizumab alone or in combination with photodynamic therapy vs photodynamic therapy for polypoidal choroidal vasculopathy: a systematic review and Meta-analysis. Int J Ophthalmol 2015; 8:1056-66. [PMID: 26558226 DOI: 10.3980/j.issn.2222-3959.2015.05.36] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/30/2015] [Indexed: 01/10/2023] Open
Abstract
AIM To compare the efficacy of intravitreal ranibizumab (IVR) alone or in combination with photodynamic therapy (PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy (PCV). METHODS A systematic search of a wide range of databases (including PubMed, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials (RCTs) and non-RCT studies were included. Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale. RevMan 5.2.7 software was used to do the Meta-analysis. RESULTS Three RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12 (All P≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs. The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity (BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6 and 24 (All P<0.05), respectively. In the mean time, this comparison result was also significant at month 12 (P<0.01) after removal of a heterogeneous study. CONCLUSION IVR has non-inferiority compare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV.
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Affiliation(s)
- Kai Tang
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Jun-Kang Si
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Da-Dong Guo
- Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Yan Cui
- Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Yu-Xiang Du
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Xue-Mei Pan
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Hong-Sheng Bi
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
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García-Layana A, Figueroa MS, Araiz J, Ruiz-Moreno JM, Gómez-Ulla F, Arias-Barquet L, Reiter N. Treatment of Exudative Age-related Macular Degeneration: Focus on Aflibercept. Drugs Aging 2015; 32:797-807. [PMID: 26442858 PMCID: PMC4607716 DOI: 10.1007/s40266-015-0300-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A formulation of aflibercept for intravitreal injection (Eylea) is approved for the treatment of patients with exudative age-related macular degeneration (AMD). Aflibercept has a significantly higher affinity for Vascular endothelial growth factor (VEGF)-A compared with other monoclonal anti-VEGF antibodies. In addition to binding all VEGF-A isoforms, aflibercept also blocks other proangiogenic factors such as VEGF-B and placental growth factor. The VIEW 1 and 2 trials showed this drug achieves improved results in patients with exudative AMD similar to those obtained with monthly ranibizumab, using a bimonthly treatment regimen after a loading dose of three intravitreal injections, which translates to less use of healthcare resources. There is a subgroup of patients that present with persistent fluid after the loading dose that could benefit from monthly injections or personalized proactive treatment after the first year. In the second year of treatment, the Treat and Extend patterns can permit even more lengthening of the time between injections. More data are needed to confirm the optimal monitoring and retreatment dosing, to maintain long-term efficacy. Other preliminary data suggest that patients that do not respond to other anti-angiogenics and patients with special pathologies such as polypoidal choroidopathy or retinal angiomatous proliferation can improve upon switching to aflibercept. To date, the safety profile of aflibercept is excellent and is comparable to other anti-angiogenic treatments.
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MESH Headings
- Aged
- Aged, 80 and over
- Aging/pathology
- Angiogenesis Inhibitors/administration & dosage
- Angiogenesis Inhibitors/adverse effects
- Angiogenesis Inhibitors/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Clinical Trials as Topic
- Drug Administration Schedule
- Female
- Humans
- Intravitreal Injections
- Male
- Middle Aged
- Ranibizumab/administration & dosage
- Ranibizumab/adverse effects
- Ranibizumab/therapeutic use
- Receptors, Vascular Endothelial Growth Factor/administration & dosage
- Receptors, Vascular Endothelial Growth Factor/adverse effects
- Receptors, Vascular Endothelial Growth Factor/therapeutic use
- Recombinant Fusion Proteins/administration & dosage
- Recombinant Fusion Proteins/adverse effects
- Recombinant Fusion Proteins/therapeutic use
- Treatment Outcome
- Vascular Endothelial Growth Factor A/metabolism
- Wet Macular Degeneration/drug therapy
- Wet Macular Degeneration/metabolism
- Wet Macular Degeneration/pathology
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Affiliation(s)
- Alfredo García-Layana
- Department of Ophthalmology, Clinica Universidad de Navarra, Pio XII 36, 31080, Pamplona, Navarra, Spain.
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain.
| | - Marta S Figueroa
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain
- Vissum Madrid, Department of Retina and Vitreous, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Araiz
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain
- Ophthalmology Service, Hospital San Eloy, Barakaldo, Bizcaia, Spain
| | - José M Ruiz-Moreno
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain
- Instituto Europeo de la Retina, Clínica Baviera, Universidad de Castilla La Mancha, Albacete, Spain
| | - Francisco Gómez-Ulla
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain
- Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, A Coruña, Spain
| | - Luis Arias-Barquet
- Sociedad Española de Retina y Vítreo (SERV), Red Temática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain
- Ophthalmology Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nicholas Reiter
- Department of Ophthalmology, Clinica Universidad de Navarra, Pio XII 36, 31080, Pamplona, Navarra, Spain
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Kim KH, Kim JH, Chang YS, Lee TG, Kim JW, Lew YJ. Clinical Outcomes of Eyes with Submacular Hemorrhage Secondary to Age-related Macular Degeneration Treated with Anti-vascular Endothelial Growth Factor. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:315-24. [PMID: 26457037 PMCID: PMC4595257 DOI: 10.3341/kjo.2015.29.5.315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/14/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the long-term outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) monotherapy for patients diagnosed with submacular hemorrhage secondary to exudative age-related macular degeneration. Methods This retrospective, observational study included 49 patients (49 eyes) who initially presented with submacular hemorrhage associated with exudative age-related macular degeneration and who were followed-up for at least 24 months. Only eyes that were treated with intravitreal anti-VEGF monotherapy were included in the study. Best-corrected visual acuity (BCVA) measurements obtained at diagnosis, six months, and the final visit were compared. The associations of BCVA at the final visit with baseline BCVA, BCVA at six months, symptom duration, hemorrhage extent, and central foveal thickness were also analyzed. Results Over the course of follow-up (mean, 32.1 ± 8.5 months), an average of 5.1 ± 2.2 anti-VEGF injections were administered. Recurrent hemorrhage was noted in 13 eyes (26.5%). The mean logarithm of the minimal angle of resolution BCVA at diagnosis, six months, and the final visit were 1.40 ± 0.52, 0.87 ± 0.64, and 1.03 ± 0.83, respectively. Both baseline BCVA (p = 0.012) and BCVA at six months (p < 0.001) were significantly associated with BCVA at the final visit. Conclusions Improved visual acuity was maintained for more than two years with intravitreal anti-VEGF monotherapy. BCVA at six months is a useful clinical index to predict long-term visual prognosis.
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Affiliation(s)
- Kun Hae Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Tae Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Young Ju Lew
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Polypoidal choroidal vasculopathy in patients aged less than 50 years: characteristics and 6-month treatment outcome. Graefes Arch Clin Exp Ophthalmol 2015; 254:1083-9. [PMID: 26384678 DOI: 10.1007/s00417-015-3173-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/31/2015] [Accepted: 09/02/2015] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To investigate the characteristics and 6-month treatment outcome of polypoidal choroidal vasculopathy (PCV) in patients aged <50 years. METHODS This retrospective study included 22 eyes from 22 patients who were <50 years old and had been diagnosed with treatment naïve PCV. Analyses of treatment outcome were performed in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy. Eyes that exhibited submacular hemorrhage of ≥1 disc diameter and involving the fovea were included in the hemorrhage group. The remaining eyes were included in the no-hemorrhage group. The baseline best-corrected visual acuity (BCVA) was compared with that at 6 months within each group. RESULTS The mean age of the 22 patients was 46.5 ± 1.8 (range, 43-49) years. Submacular hemorrhage was noted in ten eyes (45.5 %). The presence of drusen was noted in one eye and pseudodrusen was not noted in any of the eyes included. Treatment outcome was analyzed in 18 eyes. A mean number of 2.9 ± 0.5 intravitreal anti-VEGF injections were administered during the 6-month follow-up period. In the no-hemorrhage group (n = 10), the BCVA at diagnosis and at 6 months was 0.55 ± 0.32 and 0.35 ± 0.22 respectively (P = 0.011). In the hemorrhage group (n = 8), the values were 0.99 ± 0.45 and 0.74 ± 0.63 respectively (P = 0.128). CONCLUSIONS A relatively high proportion of young PCV patients exhibited submacular hemorrhage at initial presentation. In those without submacular hemorrhage, intravitreal anti-VEGF therapy was found to be beneficial.
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91
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High-dose ranibizumab monotherapy for neovascular polypoidal choroidal vasculopathy in a predominantly non-Asian population. Eye (Lond) 2015; 29:1427-37. [PMID: 26337944 DOI: 10.1038/eye.2015.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/06/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine safety and efficacy of intravitreal high-dose ranibizumab in the treatment of active neovascular polypoidal choroidal vasculopathy (PCV). METHODS In this Phase I/II, single-center, randomized, controlled, double-masked study, predominantly non-Asian, previously treated or treatment-naive, male and female adult patients were randomized to receive high-dose (1.0/0.1 ml or 2.0 mg/0.05 ml; n=15) or standard-dose (0.5 mg/0.05 ml; n=5) ranibizumab in 3 monthly loading doses, followed by 9 months of criteria-based, as-needed retreatment. Safety was evaluated by a descriptive analysis of all non-serious and serious adverse events, angiographic assessments, physical examinations, vital signs, ocular examinations, and visual acuity measurements. Visual acuity and anatomic outcomes are described for the high-dose group. RESULTS Twenty patients (aged 35-76 years; 8 Black, 11 White, 1 Asian) were enrolled. At baseline, in the high-dose group, mean best-corrected visual acuity (BCVA) was 63.5 letters (Snellen equivalent ~20/50), and mean baseline central foveal thickness (CFT) was 253.7 μm. High-dose ranibizumab was generally well tolerated without evidence of ocular or systemic severe adverse events, including arterial thromboembolic events. At month 12, in the high-dose group, the mean overall change from baseline in BCVA was +6.7 letters and in CFT was -49.7 μm. CONCLUSION High-dose ranibizumab monotherapy is safe and efficacious for treating patients with PCV.
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92
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Tan CS, Lim TH, Hariprasad SM. Current Management of Polypoidal Choroidal Vasculopathy. Ophthalmic Surg Lasers Imaging Retina 2015; 46:786-91. [DOI: 10.3928/23258160-20150909-02] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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93
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INITIAL VERSUS DELAYED PHOTODYNAMIC THERAPY IN COMBINATION WITH RANIBIZUMAB FOR TREATMENT OF POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2015; 35:1569-76. [PMID: 25830698 DOI: 10.1097/iae.0000000000000526] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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94
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Yong M, Zhou M, Deng G. Photodynamic therapy versus anti-vascular endothelial growth factor agents for polypoidal choroidal vasculopathy: a meta-analysis. BMC Ophthalmol 2015. [PMID: 26209516 PMCID: PMC4513969 DOI: 10.1186/s12886-015-0064-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to evaluate the efficacy and tolerability of photodynamic therapy (PDT) compared to intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of polypoidal choroidal vasculopathy (PCV). Methods Relevant studies were selected through an extensive search of the PubMed, EMBASE, Web of Science, and Cochrane Library databases. Outcomes of interest included visual outcomes, anatomic variables, and adverse events. Results Six studies enrolling a total of 346 patients were included. The weighted mean differences (WMDs) of the mean changes in LogMAR VA when comparing PDT with anti-VEGF were −0.02 (95 % confidence interval [CI]: −0.12–0.08) at 3 months, 0.02 (95 % CI: −0.12–0.16) at 6 months, 0.02 (95 % CI: −0.15–0.18) at 12 months, and −0.17 (95 % CI: −0.90–0.55) at 24 months. There were no significant differences between the two groups at any of the time points. PDT was found to be associated with greater reduction of central retinal thickness (CRT) at six months (WMD: 44.94; 95 % CI: 16.44–73.44; P = 0.002), and it was superior to anti-VEGF therapy in achieving complete polyp regression (odd ratio, OR: 6.85; 95 % CI: 2.15–21.79; P = 0.001).Rates of adverse events did not differ significantly between the two treatments. Conclusions PDT appeared to result in greater CRT reduction at six months and higher polyp regression rate. However, the two treatments appear to be comparable in terms of best corrected visual acuity change and adverse events.
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Affiliation(s)
- Meng Yong
- Division of Opthalmology, Third People's Hospital of Changzhou, Changzhou, China.
| | - Minwen Zhou
- Department of Ophthalmology, Shanghai First People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Guohua Deng
- Division of Opthalmology, Third People's Hospital of Changzhou, Changzhou, China
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Yamamoto A, Okada AA, Kano M, Koizumi H, Saito M, Maruko I, Sekiryu T, Iida T. One-Year Results of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy. Ophthalmology 2015; 122:1866-72. [PMID: 26088619 DOI: 10.1016/j.ophtha.2015.05.024] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To investigate 1-year outcomes of intravitreal aflibercept for polypoidal choroidal vasculopathy (PCV). DESIGN Retrospective, multicenter, consecutive case series. PARTICIPANTS A total of 90 eyes of 87 patients with treatment-naïve PCV followed at 3 tertiary centers. METHODS Clinical records were reviewed and imaging studies were analyzed of eyes with PCV that underwent 3 consecutive monthly aflibercept injections followed by injections every 2 months. Additional (rescue) injections were performed for worsening. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and angiographic findings at 1 year. RESULTS The mean BCVA (logarithm of the minimum angle of resolution units) of the 90 eyes improved from 0.31 at baseline to 0.17 at 12 months (P < 0.001). The mean central retinal thickness decreased from 315 μm at baseline to 204 μm at 12 months (P < 0.001). At 12 months, 64 eyes (71.1%) achieved a dry macula, defined as absence of intraretinal or subretinal fluid on OCT. Of 83 eyes that underwent indocyanine green angiography at both baseline and 12 months, 46 (55.4%) showed complete and 27 (32.5%) showed partial resolution of polypoidal lesions. Eleven of 82 eyes (13.4%) showed decreased size of branching choroidal vascular networks. CONCLUSIONS Intravitreal aflibercept administered over 1 year improved both visual acuity and macular morphology in a large number of treatment-naïve eyes with PCV.
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Affiliation(s)
- Akiko Yamamoto
- Department of Ophthalmology at Kyorin University School of Medicine, Tokyo, Japan
| | - Annabelle A Okada
- Department of Ophthalmology at Kyorin University School of Medicine, Tokyo, Japan.
| | - Mariko Kano
- Department of Ophthalmology at Fukushima Medical University, Fukushima, Japan
| | - Hideki Koizumi
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masaaki Saito
- Department of Ophthalmology at Fukushima Medical University, Fukushima, Japan
| | - Ichiro Maruko
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology at Fukushima Medical University, Fukushima, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
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One-year result of aflibercept treatment on age-related macular degeneration and predictive factors for visual outcome. Am J Ophthalmol 2015; 159:853-60.e1. [PMID: 25634529 DOI: 10.1016/j.ajo.2015.01.018] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the efficacy of periodic injection of aflibercept in each subtype of age-related macular degeneration (AMD) and to explore the predictive factors for visual outcome in clinical settings. DESIGN Prospective nonrandomized interventional case series. METHODS Patients with AMD were recruited and were administered aflibercept injections once a month for 3 months followed by once every 2 months for 8 months. The logarithm of the minimal angle of resolution (logMAR) at 12 months and improvement of vision from baseline were compared among polypoidal choroidal vasculopathy (PCV), retinal angiomatous proliferation (RAP), and typical AMD. Regression rate of polypoidal lesions was assessed. We also performed regression analysis with logMAR at 12 months as the dependent variable. RESULTS The study sample consisted of 98 patients: 46 had typical AMD, 42 had PCV, and 10 had RAP. Mean logMAR improved from 0.36 to 0.21 in 12 months. While there was no difference in visual improvement between typical AMD and PCV, final logMAR was better in PCV (0.32 ± 0.09 vs 0.08 ± 0.04, P = .016). Thirty-nine PCV patients underwent follow-up angiography, and regression of polyps was observed in 27 cases (69.2%). Multiple regression analysis showed that the presence of external limiting membrane (ELM), smaller greatest linear dimension, and the presence of polypoidal lesion were associated with better visual outcome (R(2) = 0.53, P = 2.73 × 10(-14)). CONCLUSIONS Periodic injection of aflibercept is effective for PCV as well as for typical AMD. The statuses of ELM, greatest linear dimension, and polypoidal lesion are predictive for visual outcome.
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Wong CW, Wong TY, Cheung CMG. Polypoidal Choroidal Vasculopathy in Asians. J Clin Med 2015; 4:782-821. [PMID: 26239448 PMCID: PMC4470199 DOI: 10.3390/jcm4050782] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/13/2015] [Indexed: 01/16/2023] Open
Abstract
Age related macular degeneration (AMD) in Asians has been suggested to differ from their Western counterparts in terms of epidemiology, pathogenesis, clinical presentation and treatment. In particular, polypoidal choroidal vasculopathy (PCV) appears to be the predominant subtype of exudative AMD in Asian populations, in contrast to choroidal neovascularization secondary to AMD (CNV-AMD) in Western populations. Epidemiological data on PCV has been largely limited to hospital-based studies and there are currently no data on the incidence of PCV. Similarities and differences in risk factor profile between PCV and CNV-AMD point to some shared pathogenic mechanisms but also differential underlying mechanisms leading to the development of each phenotype. Serum biomarkers such as CRP, homocysteine and matrix metalloproteinases suggest underlying inflammation, atherosclerosis and deranged extracellular matrix metabolism as possible pathogenic mechanisms. In addition, recent advances in genome sequencing have revealed differences in genetic determinants of each subtype. While the standard of care for CNV-AMD is anti-vascular endothelial growth factor (VEGF) therapy, photodynamic therapy (PDT) has been the mainstay of treatment for PCV, although long-term visual prognosis remains unsatisfactory. The optimal treatment for PCV requires further clarification, particularly with different types of anti-VEGF agents and possible benefits of reduced fluence PDT.
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Affiliation(s)
- Chee Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, 168751 Singapore, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, 169857 Singapore, Singapore.
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, 168751 Singapore, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, 169857 Singapore, Singapore.
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, 168751 Singapore, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, National University of Singapore, 169857 Singapore, Singapore.
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Hikichi T. Individualized ranibizumab therapy strategies in year 3 after as-needed treatment for polypoidal choroidal vasculopathy. BMC Ophthalmol 2015; 15:37. [PMID: 25881324 PMCID: PMC4393615 DOI: 10.1186/s12886-015-0026-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/28/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To investigate the third-year results of ranibizumab monotherapy for polypoidal choroidal vasculopathy (PCV) in individualized treatment regimens based on the outcomes during 2 years. METHODS One hundred seventy-two consecutive eyes of 163 prospective treatment-naïve patients with PCV were treated with three monthly intravitreal ranibizumab injections followed by as-needed reinjections and completed a 2-year follow-up. Treatment regimens during the third year were selected individually based on their outcomes from the following treatment regimens: as-needed injections based on quarterly examinations, as-needed injections based on monthly examinations, a monthly ranibizumab injection schedule, and the treat-and-extend schedule. Visual acuity (VA) and foveal thickness at the end of the third year and the prevalence of discontinuous follow-up examinations during the third year were evaluated. RESULTS Of 163 patients, 35 (21%) patients were excluded; nine patients had discontinuous follow-up examinations during the third year. In 128 eyes of 128 patients studied during the third year, the significant improvements in VA and foveal thickness 2 years after the first injection compared to baseline were maintained at the end of the third year. Six (18%, 6/34) patients treated with as-needed injections based on quarterly examinations had discontinuous follow-up examinations, the prevalence of which differed significantly (P = 0.025) from the other groups. CONCLUSIONS The individualized treatment strategies in the third year based on each patient's outcomes during 2 years maintained the improved VA and avoided discontinuation of follow-up during the third year.
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Affiliation(s)
- Taiichi Hikichi
- Ohtsuka Eye Hospital, Kita-16 Nishi-4, Kita-ku, Sapporo, 001-0016, Japan.
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Kim JH, Kim JW, Lee TG, Lew YJ. Treatment outcomes in eyes with polypoidal choroidal vasculopathy with poor baseline visual acuity. J Ocul Pharmacol Ther 2015; 31:241-7. [PMID: 25786032 DOI: 10.1089/jop.2014.0145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate treatment outcomes of intravitreal vascular endothelial growth factor (VEGF) in eyes with polypoidal choroidal vasculopathy (PCV) that exhibited poor baseline visual acuity. METHODS This retrospective, observational study included 47 eyes with treatment-naïve PCV with baseline visual acuity of 20/200 or worse treated with intravitreal anti-VEGF. Eyes were divided into 2 groups according to the presence of submacular hemorrhage (hemorrhage and no-hemorrhage groups). The best-corrected visual acuity (BCVA) at baseline was compared with that measured at 3 and 6 months after treatment. RESULTS A mean of 3.3±0.9 intravitreal anti-VEGF injections were performed during the 6-month follow-up period. In the hemorrhage group (n=23), 6 patients additionally underwent pneumatic displacement with or without intravitreal tissue plasminogen activator. The logarithm of minimal angle of resolution BCVA at diagnosis, 3, and 6 months was 1.47±0.49, 0.91±0.79, and 0.81±0.83, respectively. Compared with baseline, BCVA was significantly better at 3 and 6 months (P=0.007 and P=0.001, respectively). In the no-hemorrhage group (n=24), the BCVA at defined time points was 1.23±0.32, 1.06±0.33, and 1.02±0.35, respectively. BCVA was significantly better at 3 and 6 months compared with baseline (P=0.006 and P=0.025, respectively). CONCLUSIONS Intravitreal anti-VEGF was found to be beneficial in PCV eyes with poor baseline visual acuity, regardless of the presence of submacular hemorrhage. The magnitude of visual improvement was relatively greater in eyes with submacular hemorrhage.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine , Seoul, South Korea
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Shin JY, Choi M, Chung B, Byeon SH. Pigment epithelial tears after ranibizumab injection in polypoidal choroidal vasculopathy and typical age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2015; 253:2151-60. [DOI: 10.1007/s00417-015-2977-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/16/2015] [Accepted: 02/18/2015] [Indexed: 01/09/2023] Open
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